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A. Anton–Lopez, F. Blazquez, M. Sebatian, S. Fernandez, M. Reyes; Telemedicine System for the Detection of Glaucoma: Implementation and Initial Results . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3419.
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Implementation and evaluation of a glaucoma screening protocol applicable through a telemedicine system in a population at risk for glaucoma.
Specific software, performed in JAVATm, was developed to integrate the information from a clinical questionnaire and the different examination devices. A MySQL database handles and stores the data within the telemedicine system. The software complies with the current laws about safe patient data transmission. Standard procedures for a medical history questionnaire, keratometry and auto–refractometry (Topcon) ultrasound pachymetry (IOPAC–Heidelberg), non–contact tonometry (Topcon), Frequency doubling technology perimetry (Humphrey Instruments) and Confocal scanning laser ophthalmoscopy (HRT, Heidelberg Engineering) were defined. The remote station was installed in a primary care center and instant communication with the reading center was obtained with a 512/128 DSL line. Posters were used to announce the study and stimulated volunteer participation. Inclusion criteria included age over 65 y. or age over 40 y. and one of the following: family history of glaucoma or ocular hypertension. All participants signed an informed consent.
Six hundred and forty one volunteers at risk for glaucoma participated in the study after signing an inform consent. Inclusion criteria included age over 65 y. or age over 40 y. and one of the following: family history of glaucoma or ocular hypertension. Mean (SD) total examination time per subject was 49 (18) minutes. After two examinations per eye, 22.3 of subjects (n:143) had pathologic FDT and 4.2% (n:27) showed pathologic HRT. Good quality HRT images could not be obtained in 31 subjects (4,8%). IOP was over 21 mmHg in at least one eye in 17.1% of subjects (n:110). Each patient received a written report with the results and an advice regarding the need for ophthalmic consultation. Each patient received a written report with the results and an advice regarding the need for ophthalmic consultation.
The telemedicine system designed is able to handle, integrate and transmit functional and structural optic nerve data from the remote to the reading centre. In the studied population at risk, prevalence of IOP over 21 mmHg was 17%. Total evaluation time was rather long and recommends re–evaluation of the screening protocol.
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